Reduction in cardiovascular mortality following severe hypoglycemia in individuals with type 2 diabetes: the role of a pragmatic and structured intervention

Abstract

Background Mortality in individuals with diabetes with severe hypoglycemia requiring ambulance services intervention is high and it is unclear whether this is modifiable. Our aim was to characterise this high-risk group and assess the impact of nurse-led intervention on mortality. Methods In this single centre study, patients with diabetes and hypoglycemia requiring ambulance call out were randomized to nurse led support (intensive arm) or managed using existing pathways (standard arm). A third group agreed to have their data collected longitudinally (observational arm). The primary outcome was all-cause mortality comparing intensive with combined standard and observational arms as well as standard arm alone. Results Of 828 individuals identified, 323 agreed to participate with 132 assigned to intensive, 130 to standard and 61 to observational arms. Mean follow up period was 42.6 ± 15.6 months. Mortality in type 1 diabetes (n = 158) was similar across study arms but in type 2 diabetes (n = 160) this was reduced to 33% in the intensive arm compared with 51% in the combined arm (p = 0.025) and 50% in the standard arm (p = 0.06). Cardiovascular deaths, the leading cause of mortality, was lower in the intensive arm compared with combined and standard study arms (p < 0.01). Conclusions Medium-term mortality following severe hypoglycemia requiring the assistance of emergency services is high in those with type 2 diabetes. In individuals with type 2 diabetes, nurse-led individualized intervention reduces cardiovascular mortality compared with standard care. Large-scale multicentre studies are warranted to further investigate this approach. Trial registration The trial was retrospectively registered on http://www.clinicaltrials.gov with reference NCT04422145

The Interplay between Non-Esterified Fatty Acids and Plasma Zinc and Its Influence on Thrombotic Risk in Obesity and Type 2 Diabetes

“…Obesity and type-2 diabetes mellitus (T2DM) are two closely related disorders, the former being associated with a high body mass index (BMI; >30 kg/m 2 ) and the latter with insulin resistance and inadequate glycemic control. Both conditions predispose an individual to vascular complications [ 1 , 2 , 3 , 4 ]. Increased vascular risk in these diseases is driven by the establishment of a hypercoagulable state of the plasma [ 5 ], which can include the formation of intravascular obstructive blood clots (leading to heart attacks and strokes).…”

Risk factors associated with mortality in individuals with type 2 diabetes following an episode of severe hypoglycaemia. Results from a randomised controlled trial

“…We studied cause of death across the two groups using death certificates, and full details can be found elsewhere. 9 The main cause of death in the whole group was infections, followed by cardiovascular disease. There was a clear difference in cardiovascular death, comparing the two study arms with a single cardiovascular death occurring in the intervention arm (1.7%) vs 12 (18.8%) in the standard arm ( p = 0.002).…”

“…We performed an exploratory post-hoc analysis using data from a previously published RCT 9 (clinical trial registration NCT04422145). The RCT received ethical approval from the UK National Health Service Health Research Authority (reference 100244), and all participants gave written informed consent.…”

SGLT-2 inhibitors for treatment of heart failure in patients with and without type 2 diabetes: A practical approach for routine clinical practice

“…Our purpose is therefore to provide a few but important suggestions on how to initiate an SGLT-2i in a diabetic patient with HFrEF, especially when frailty is present. Beyond the possible (although rare) risk of euglycemic diabetic ketoacidosis (eDKA) described below, the major risk in patients with diabetes is induction of hypoglycemia, usually associated with higher mortality rates [26]. Non-endocrinologists should therefore carefully evaluate a series of parameters before initiation of another medicine for diabetes which might induce a significant adverse event.…”